Session 24: Some Aspects On Treatment Of Gynaecological Malignancies

Question 1

Carcinoma of Vulva

Answer 1

• Rare
• <5% of female genital tract cancer
• 7th decade of life
• Presented late
• 10% associated with other genital tract cancer

2 types:
1. HPV infection-associated
- Younger women
- “Usual type”

2. Lichen sclerosis-associated
   - Elderly women
   - Differentiated

Risk factors:
Usual type:
- Precursor: Usual VIN (Vulval intraepithelial neoplasm)
—> HPV
—> Smoking
—> Immunodeficiency

Differentiated type:
- Precursor: Differentiated VIN
—> Chronic vulval dystrophy
—> Leukoplakia

Clinical features:
1. Pruritus vulva
2. Discharge
3. Bleeding
4. Nodule
5. Ulcer
6. Pain

Appearance:
- Ulcer
- Indurated
- Raised
- Growth
- Nodular
- Irregular
- Fissures
- Unifocal / Multifocal

Diagnosis:
- Biopsy of lesion

Treatment:
1. Surgery (Early disease)
- Radical vulvectomy + Bilateral groin lymphadenectomy
- Modification according to size / depth of invasion of tumour

2. RT, ChemoRT, Surgery (Advanced disease)

Question 2

Paget’s disease of Vulva

Answer 2

• Weeping appearance
• Carcinoma-in-situ
• Paget’s cell
• Associated with other cancer